Abstract P299: Heart Brain Clinic: Integrated Management of Ischemic Stroke

Abstract

Background: About 25% of acute ischemic strokes (IS) are categorized into stroke of undetermined etiology and many ultimately have a cardiac source for stroke. Neurologists and cardiologists can improve decision making, as has been shown with other multidisciplinary clinics. We report our experience in creating our Heart Brain Clinic (HBC) with a focus on patients with patent foramen ovale (PFO). Methods: Demographic and clinical data were collected retrospectively for patients with PFO evaluated for IS in the inpatient or outpatient setting. Patients were divided into routine care and HBC groups. We compared time from stroke to PFO closure and number of clinic visits prior to decision about closure. Nonparametric analysis was used to calculate difference between medians, while chi square test was used for categorical values. Results: HBC began in 12/2018 with coordination of administrative and staffing efforts between neurology and cardiology departments. From 2/17 to 7/20, 73 patients were evaluated for PFO (42 routine care, 31 HBC; Table 1). At the time of data analysis, 67 patients had received recommendations about PFO closure and 52 patients underwent PFO closure. More than 50% of all patients traveled from outside Houston. HBC patients required fewer clinic visits (p=0.023) prior to decision about closure; however, in patients who underwent PFO closure, there was no difference in weeks from stroke to closure. Patients seen in HBC were recommended to not undergo closure more often than routine care (p= 0.007) Conclusions: Our data demonstrates that a multidisciplinary, patient-centered approach to management of IS patients with PFO is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of healthcare.